Notice of Privacy Practices - Greater Baltimore Medical Center

Notice of Privacy Practices - Greater Baltimore Medical Center

Notice of Privacy Practices

Effective September 1, 2010

6701 North Charles street

Baltimore, mD 21204

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This notice describes how health

information about you may be used

and disclosed and how you can get

access to this information.

Please review it carefully.

If you have any questions, please contact our

Privacy Officer at the address or phone

number listed at the end of this Notice.

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Our Responsibilities

We take the privacy of your health information seriously and we are

committed to protecting your health information. This Notice applies

to all records of your care that we maintain, which contain your

protected health information (PHI). Protected health information is

medical information that identifies you or may provide a basis for

identifying you. Your personal doctor may have different policies

or notices regarding the doctor’s use and disclosure of your health

information created in the doctor’s office. This Notice is provided

to tell you about the duties and practices of GBMC Healthcare with

respect to your health information. We are required by law to provide

you with this Notice, and we are required to follow the terms of the

Notice that is currently in effect.

Who This Notice Applies To

This Notice describes the privacy practices of those individuals or

entities listed below:

Greater Baltimore Medical Center (GBMC) and all affiliated

entities and

• Gilchrist Hospice Care.

In addition, these individuals or entities may share PHI with each

other for treatment, payment or healthcare operation purposes

described in this Notice.

Changes to this Notice

We reserve the right to change this Notice. We reserve the right to

make the revised Notice effective for health information we already

have about you as well as any information we receive in the future.

How we may use and disclose your health information

The following categories describe and give examples of the different

ways that we may use and disclose your health information. All of the

ways we are permitted to use and disclose your information will fall

within one of these categories.

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• Treatment

We may use PHI about you to provide you with treatment. We

may disclose your PHI to doctors, nurses, aides, technicians or

members of the workforce (including contracted employees),

pharmacists, suppliers of medical equipment or other healthcare

professionals who are involved directly or indirectly with your

care. For example, we may use and disclose your PHI for treatment

purposes if we need to request the services of an outside

laboratory to perform blood tests that are more extensive than

those that would be performed by our in-house laboratory.

• Payment

We may use and disclose your PHI for payment purposes. We

will bill and collect for the treatment and services we provide

to you. We may send your PHI to an insurance company or

third party for payment purposes including a collection service.

For example, we may use and disclose your PHI for payment

purposes if we contact your insurance company in order to

obtain approval for an admission or procedure.

• Healthcare Operations

We may use and disclose your PHI for healthcare operations.

These uses and disclosures are necessary to make sure that you

receive competent, quality healthcare and to maintain and

improve the quality of healthcare that we provide. For example,

we may use your PHI for performance improvement activities,

which would contribute to our mission of providing medical

care and service of the highest quality to each patient.

• Health Information Exchanges

We participate in the Chesapeake Regional Information System

for our Patients, Inc. (CRISP), a state-wide health information

exchange. As permitted by law, your health information will be

shared among several health care providers or other health care

entities in order to provide faster access, better coordination of

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care and assist providers and public health officials in making

more informed decisions. This means we may share information

we obtain or create about you with outside entities (such as

doctors’ offices, labs, or pharmacies) or we may receive

information they create or obtain about you (such as medical

history or billing information) so each of us can provide better

treatment and coordination of your healthcare services. You

may “opt-out” and prevent searching of your health information

available through CRISP by calling 1-877-952-7477 or completing

and submitting an Opt-Out form to CRISP by mail, fax or

through their website at Even if you

opt-out, a certain amount of your information will be retained

by CRISP and your ordering or referring physicians, if

participating in CRISP, may access diagnostic information

about you, such as reports of imaging and lab results.

• Permitted Uses without Prior Authorization

We may use or disclose your PHI without your prior authorization

for several other reasons. Subject to certain requirements,

we may give out health information about you without prior

authorization for public health purposes, abuse or neglect

reporting, health oversight audits or inspections, research studies

(chart review only), funeral arrangements and organ donation,

worker’s compensation purposes, and emergencies. We also

disclose health information when required by law, such as in

response to a request from law enforcement in specific circumstances,

or in response to valid judicial or administrative orders.

• To Avert a Serious Threat to Health or Safety

We may use and disclose your necessary PHI when we believe

it is necessary to prevent a serious threat to your health and

safety or the health and safety of the public or another person.

Any disclosure, however, would only be to someone able to help

prevent or lessen the threat or to law enforcement authorities in

particular circumstances.

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• Specialized Government Functions

If you are in the military or are a veteran, we will disclose your

health information as required by command authorities. We

may disclose health information to authorized federal officials

for national security purposes, such as protecting the President

of the United States or for authorized intelligence operations.

• Correctional Institution and Other Law Enforcement Custodial


We may disclose to a correctional institution or law enforcement

official having lawful custody of an inmate or other individual,

PHI about the inmate or individual if the correctional institution

or law enforcement authority makes certain representations to

us, proving that the disclosure of the PHI is necessary.

• Treatment Alternatives, Appointment Reminders and Health-

Related Benefits

We may use and disclose your PHI to tell you about or recommend

possible treatment alternatives or health-related benefits

or services that may be of interest to you. Additionally, we may

use and disclose your PHI to provide appointment reminders. If

you do not wish us to contact you about treatment alternatives,

health-related benefits or appointment reminders, you must

notify the Privacy Officer in writing and state from which of

those activities you wish to be excluded.

• Fundraising Activities

We may use certain information (e.g., name, address, telephone

number, dates of service, age and gender) to contact you in an

effort to raise money for our operations. We may also provide

this information to our related foundation for the same purpose.

The money raised will be used to expand and improve the services

and programs we provide to the community. We do not sell the

information that we are allowed by law to receive. If you do not

want us to contact you for fundraising efforts, you must notify

the Privacy Officer in writing.

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• Patient Information Directory

We may include certain limited information about you in our

patient information directory. This information may include

your name, location in the facility, your general condition (e.g.,

stable, guarded, serious and critical) and your religious affiliation.

The directory information, except for your religious affiliation,

may also be released to people who ask for you by name. Your

religious affiliation may be given to a member of the clergy,

such as a priest, minister or rabbi even if they do not ask for

you by name. You will be asked at the time of registration if you

would like to be included in our patient information directory.

If you choose not to be listed in our patient information

directory, callers and visitors who ask for you by name

will be told, “There is no one listed by that name.” However,

if you do choose not to be listed in our patient information

directory but still wish to receive visitors or calls then you must

release your room number and phone number yourself. We will

gladly direct visitors to your room as long as you have provided

them with that information prior to them entering our facility.

• Individuals Involved in Your Care or Payment for Your Care

We may release health information about you to a family

member, other relative or any other person identified by you

who is involved in your healthcare with your permission. We

may also give information to someone who helps pay for your

care. We may also tell your family, friends, personal representative

or other person responsible for your healthcare your condition

while you are at the facility.

• Third Parties

We may disclose your PHI to third parties with whom we

contract to perform services on our behalf. If we disclose your

information to these entities, we will have an agreement with

them to safeguard your information.

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Other Uses of Health Information

Other uses and disclosures of health information not covered by

this Notice or the laws that apply to us will be made only with your

written authorization. Examples of PHI disclosures that require

your authorization include disclosures of psychotherapy notes and

disclosures for purposes of marketing, among others. If you provide

us authorization to use or disclose your PHI, you may revoke that

authorization, in writing, at any time. If you revoke your authorization,

we will no longer use or disclose PHI about you for the reasons

covered by your written authorization. You understand that we are

unable to take back any disclosures we may have already made under

the authorization.

Your Rights Regarding Your Health Information

All request forms relating to your rights as mentioned below may be

obtained from the Medical Records department at the treating facility.

You have the following rights regarding health information we

maintain about you:

• Right to See and Copy Your Health Record

You have the right to review or get a copy of your health record.

Please make your request in writing to the Medical Records

department where you received treatment. If you request a copy

of the information, we may charge a fee for the costs of copying,

mailing or other supplies associated with your request.

• Right to Amend (Update) Your Health Record

If you believe that a piece of important information is missing

from your health record, you have the right to ask us to modify,

but not delete, your health and/or billing information for as

long as the information is kept by us. You must submit your

request in writing and you must provide a reason that supports

your request. We will inform you of our decision in writing. We

may deny your request if you ask us to amend information that:

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• Was not created by us, unless the person or entity that

created the information is no longer available to make

the amendment;

• Is not part of the health information kept by or for us;

• Is not part of the information which you would be

permitted to inspect and copy; or

• Is accurate and complete.

• Right to an Accounting (List) of Disclosures We Have Made

You have the right to a list of disclosures we have made of your

health information. The list will not contain disclosures made

for purposes of treatment, payment or healthcare operations.

It will not contain disclosures that were authorized by you and

certain other disclosures excluded by law. You must submit

a written request to obtain a copy of this disclosure list. Your

request must state a time period, which may not be longer than

six years and may not include dates before April 14, 2003. The

first list you request within a 12-month period will be free. For

additional lists, during such 12-month period, we may charge

you for the costs of providing the list. We will notify you of the

cost involved, and you may choose to withdraw or modify your

request at that time.

• Right to Request Confidential Communications

You have the right to request that health information about

you be communicated to you in a confidential manner. For

example, you may ask that we call your cell phone with

appointment reminders instead of your home phone. To request

confidential communications, you must make your request in

writing. We will not ask you the reason for your request. We

will accommodate all reasonable requests. Your request must

specify how or where you wish to be contacted. We will inform

you of our decision in writing.

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• Right to Request Restrictions

You have the right to request that we limit how we use and

disclose your health information. We are legally required to

accept certain requests to not disclose health information to

your health plan for payment of healthcare operations purposes

if you have paid in full out of your own pocket for the item or

service. We are not legally required to accept any other request

for a restriction, but we will consider your request. If we do

accept it, we will comply with your request, except if you

need emergency treatment. Your request must be in writing.

To submit a request, please contact the Medical Records


Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice. You may ask us to

give you a copy of this Notice at any time. Even if you have agreed to

receive this Notice electronically, you are still entitled to a paper copy

of this Notice.


If you believe your privacy rights have been violated, or you disagree

with a decision we made about access to your records, you may

contact our Privacy Officer (listed below) or you may contact our

Privacy Hotline, which operates 24-hours-a-day, seven days a week

at 1-800-299-7991. You may also send a written complaint to the

U.S. Department of Health and Human Services, Office of Civil

Rights. Our Privacy Officer can provide you with the address. You

will not be penalized for filing a complaint.

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If you have any questions about this Notice,

please contact our Privacy Officer by using

the information provided below.

Privacy Officer c/o Compliance Dept.

Greater Baltimore Medical Center

6701 North Charles Street

Baltimore, Maryland 21204

Phone: 443-849-2000

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6701 North Charles street

Baltimore, mD 21204

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